Resilience and vulnerability in adolescents with primary headaches: A cross-sectional population-based study

Marco Antônio Arruda; Renato Arruda; J Landeira-Fernandez; Luis Anunciação; Marcelo Eduardo Bigal

doi:10.1111/head.14078

Resilience and vulnerability in adolescents with primary headaches: A cross-sectional population-based study

Headache. 2021 Mar;61(3):546-557. doi: 10.1111/head.14078. Epub 2021 Mar 15.

Authors

Marco Antônio Arruda¹, Renato Arruda², J Landeira-Fernandez³, Luis Anunciação³, Marcelo Eduardo Bigal⁴

Affiliations

¹ Department of Neuroscience, Glia Institute, Ribeirão Preto, Brazil.
² Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
³ Department of Psychology, Pontifical Catholic University, Rio de Janeiro, Brazil.
⁴ Ventus Therapeutics, Montreal, QC, Canada.

PMID: 33720394
DOI: 10.1111/head.14078

Abstract

Background: A scarcity of studies on the role of resilience resources (RRs) and vulnerability risk (VR) in children and adolescents with primary headache hampers the development of a risk-resilience model for pediatric headaches.

Objective: To examine the extent to which headache frequency and diagnosis are associated with RRs and VR and explore possible predictors of low RRs and high VR in a cross-sectional population-based study in adolescents.

Methods: This is a cross-sectional population study conducted in a small city in Brazil (Delfinópolis). Consents and analyzable data were obtained from 339/378 adolescents (89.7%). RRs and VR were assessed using the validated Brazilian version of the Resiliency Scales for Children and Adolescents, completed by the adolescents. Parents filled a structured questionnaire assessing sociodemographic and headache characteristics, as well as the Brazilian-validated version of the Strengths and Difficulties Questionnaire added to the impact supplement to evaluate the adolescent's psychosocial adjustment skills. Teachers completed a structured questionnaire about the students' school performance.

Results: A higher frequency of headache was associated with lower RRs (F_3,335 = 2.99, p = 0.031) and higher VR (F_3,335 = 4.05, p = 0.007). Headache diagnosis did not significantly influence the risk of having lower RRs or higher VR. In the exploratory analyses, females (OR 3.07; 95% CI: 1.16-9.3) and individuals with psychosocial adjustment problems (OR 7.5; 95% CI: 2.51-22.4) were predictors of low RRs, and prenatal exposure to tobacco (OR 5.6; 95% CI: 1.57-20.9) was a predictor of high VR in adolescents with primary headache.

Conclusions: The risk of low RRs and high VR was associated with a higher headache frequency, but not with headache diagnosis. These findings may contribute to the development of a risk-resilience model of headaches in the pediatric population and help identify novel targets and develop effective resources for successful interventions.

Keywords: headache; migraine; pain; resilience; vulnerability.

MeSH terms

Adolescent
Adverse Childhood Experiences*
Brazil / epidemiology
Child
Cross-Sectional Studies
Female
Headache Disorders, Primary / epidemiology*
Humans
Male
Resilience, Psychological*